MANAGEMENT

TREATMENT
BEVACIZUMAB
IN MCRC
PRESENTED BY
COLORECTAL
CANCER
• Colorectal cancer (CRC) is a leading cause of cancer-
related mortality and morbidity worldwide and represents a
significant public health challenge
BEVACIZUMAB

Bevacizumab is a recombinant humanized

monoclonal antibody that was approved for patients
Introduction
with mCRC in 2004 in combination with
fluoropyrimidine-based chemotherapy

Bevacizumab works by blocking a protein called

Pharmacology VEGF, which some cancer cells produce in large
amounts.
PHARMACOKINETICS
Absorbtion Distribution Metabolism Elemination

• A PK study concluded • The volume of distribution
bevacizumab follows is 2.9 L.
linear pharmacokinetics • After correcting for body
and is expected to reach weight, males have a
90% of steady-state larger central volume of
concentration by 84 days. distribution (3.2 L vs. 2.7
L) than females.
• The metabolism of bevacizumab • The mean clearance is
is likely identical to endogenous
0.23 L/day.
antibodies like IgG, i.e., by
proteolytic catabolism, involving
• After correcting for body
non-specific elimination weight, clearance is
pathways and target-mediated approximately 26% higher
elimination by VEGF-expressing in men than in women.
cells. Hence it doesn't affect the
activity of drug-metabolizing
enzymes in the liver.
PHARMACODYNAMICS
BEVACIZUMAB IN CRC

Efficacy? 2006: FDA Approval

CRC was the first Bevacizumab was

malignancy for which approved for the
clear evidence for the treatment of metastatic
efficacy of an anti-VEGF colorectal cancer (mCRC)
strategy was based on favorable
demonstrated in benefit-risk assessments
randomized trials from randomized
controlled trials
EVIDENCE
Avastin Registry—
Bevacizumab KORALLE Non-
Investigation of Avastin ColORectal Non-
Expanded Access Trial Interventional Cohort
Effectiveness and interventional (ACORN)
(BEAT) Study
Safety (BRITE)

• The BEAT study shows that
the efficacy and safety profile
of bevacizumab in routine
clinical practice is consistent
with results observed in
prospective randomised
clinical trials and another
large observational study in
the United States (BRiTE
study).
• In first-line mCRC • Despite different treatment
patients, the FOLFOX– intentions, the
bevacizumab and combination of
FOLFIRI–bevacizumab bevacizumab plus
regimens were associated fluoropyrimidine-based
with similar treatment chemotherapy was
patterns and clinical similarly effective in all
outcomes. subgroups in routine
clinical practice.
• There were no clear differences
observed between bevacizumab
with capecitabine-based
chemotherapy and fluorouracil-
based regimens, and confirmed
the safety profile of
bevacizumab in a real-world
UK-based population.
 REGIMENTS
• Bevacizumab administration is via intravenous (IV) infusion.
• The first infusion should be over 90 minutes and subsequent infusions over 60 minutes if the first infusion is
well tolerated. Additional infusions can be given over 30 minutes if the patient tolerates the 60-minute
infusion well.
• There are many different dosing regimens based on the type of cancer treated; most fall between 5 mg to 15
mg/kg body weight on a cyclical treatment schedule (14 or 21 days), also depending on the type of cancer
being treated.

Bevacizumab administration is via intravenous (IV) infusion. Bevacizumab comes

in 100 mg and 400 mg solutions in 4 mL and 16 mL, respectively.
REFERENCE
Dinu, I. M., Mihăilă, M., et al. (2023). Bevacizumab Treatment for Metastatic Colorectal Cancer in Real-World Clinical Practice. Medicina (Kaunas, Lithuania), 59(2), 350.
https://doi.org/10.3390/medicina59020350

Van Cutsem, E., Rivera, F., et al (2009). Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Annals of
oncology : official journal of the European Society for Medical Oncology, 20(11), 1842–1847. https://doi.org/10.1093/annonc/mdp233

Bendell, J. C., Bekaii-Saab, T. S., et al. (2012). Treatment patterns and clinical outcomes in patients with metastatic colorectal cancer initially treated with FOLFOX-bevacizumab or FOLFIRI-bevacizumab:
results from ARIES, a bevacizumab observational cohort study. The oncologist, 17(12), 1486–1495. https://doi.org/10.1634/theoncologist.2012-0190

Arnold, D., Eggers, E., et al (2022). Treatment of Metastatic Colorectal Carcinoma with Bevacizumab in First-Line and beyond First Progression: The KORALLE Non-Interventional Cohort Study.
Oncology research and treatment, 45(10), 576–587. https://doi.org/10.1159/000525031

Khakoo, S., Chau, I., Pedley, I., Ellis, R., Steward, W., Harrison, M., Baijal, S., Tahir, S., Ross, P., Raouf, S., Ograbek, A., Cunningham, D., & ACORN investigators (2019). ACORN: Observational Study of
Bevacizumab in Combination With First-Line Chemotherapy for Treatment of Metastatic Colorectal Cancer in the UK. Clinical colorectal cancer, 18(4), 280–291.e5.
https://doi.org/10.1016/j.clcc.2019.07.003

Gerriets V, Kasi A. Bevacizumab. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482126/

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